Skip to main content

18F-FDG-PET/CT can be used to predict distant metastasis in hypopharyngeal squamous cell carcinoma

Abstract

Background

Hypopharyngeal squamous cell carcinoma (HPSCC) has a high rate of distant metastasis, resulting in poor prognosis. The role of the maximum standardized uptake value (SUVmax), which was assessed via pretreatment 18-fluorodeoxyglucose positron emission tomography (FDG-PET), and computed tomography (CT) was examined, for predicting distant metastasis and survival.

Methods

This study included 121 patients who underwent pretreatment FDG-PET/CT scanning and subsequent treatment for HPSCC. The SUVmax was measured via FDG-PET/CT. A receiver operating characteristic (ROC) curve analysis was used to determine whether the SUVmax was a predictor of distant metastasis and to select the best cutoff value. Univariate and multivariate Cox hazard regression analyses were used in identifying associations between the SUVmax and other clinicopathological factors with distant metastasis-free survival.

Results

Distant metastases were identified in 33 patients during the median follow-up of 24 months after treatment. The ROC curve analysis determined that SUVmax was predictive of distant metastasis and identified a SUVmax of 13.9 as the best potential cutoff value. The univariate analysis showed that T and N classification, clinical stage, and SUVmax were significantly related to distant metastasis. However, in multivariate analysis, an SUVmax ≥ 13.9 was the only independent predictor of distant metastasis. Patients with high SUVmax values displayed significantly shorter distant metastasis-free survival and overall survival.

Conclusions

SUVmax determined via pretreatment FDG-PET/CT is useful for predicting distant metastasis, distant metastasis-free survival, and overall survival in patients with HPSCC.

Graphical Abstract

Background

Hypopharyngeal squamous cell carcinoma (HPSCC) is one of the most common head and neck cancer types. Multidisciplinary treatment is administered following the disease stage, but the prognosis is poor because of recurrence and metastasis [1, 2]. Distant metastasis is a significant prognostic factor, and its prediction affects treatment decisions [3]. Therefore, several attempts have been made to better predict distant metastases [4].

Recently, 18-fluorodeoxyglucose positron emission tomography (FDG-PET) and computed tomography (CT) have been reported as in predicting prognosis in malignant tumors, including those of the head and neck [5]. Various types of metabolic parameters can be derived from FDG-PET/CT. Among these, the maximum standardized uptake value (SUVmax) has gained much attention and has been examined as a prognostic factor in head and neck cancer [6, 7].

For HPSCC, pretreatment SUVmax has been reported as a predictor of overall survival, prognosis after salvage treatment in recurrent cases, and larynx preservation after chemoradiotherapy [8, 9]. However, few reports have focused on the significance of pretreatment SUVmax in predicting HPSCC distant metastasis [10], and further studies are required to improve its accuracy.

Therefore, the aim of this study was to investigate the utility of pretreatment FDG-PET/CT SUVmax as a prognostic factor, including its ability to predict distant metastases in patients with HPSCC.

Materials and methods

Patients

Patients who were newly diagnosed (not included patients with recurrent disease or patients who have been previously treated with HPSCC) with HPSCC had available pretherapeutic whole-body FDG-PET/CT images and received treatment with a curative intent between January 2010 and December 2018 at the Department of Otorhinolaryngology–Head and Neck Surgery of the Akita University Hospital (Akita, Japan), and were retrospectively assessed. Patients with distant metastasis before therapy (n = 6), patients who did not receive complete treatment because of poor general condition (n = 3), and patients with insufficient FDG-PET/CT data for the quantitative analyses (n = 29) were excluded. Ultimately, 121 eligible patients were included in the final analysis.

This study was conducted under the review and approval of our Institutional Review Board. Given the study's retrospective nature, informed consent from each patient was waived.

Staging and treatment

The patients were staged following the Union Internationale Contre le Cancer (UICC), TNM staging for head and neck cancer, 8th edition, 2017 [11]. The 121 patients were divided into two groups according to their primary tumor treatment modality: the first group included patients who underwent curative surgery as the first-line treatment (surgery group; n = 59). These patients were treated with postoperative radiation therapy (RT) with or without chemotherapy if they were at high risk (positive margins or less than 5-mm from the margin and/or multiple neck lymph node metastases). The second group included patients treated with radical RT with or without chemotherapy (RT group; n = 62). The primary treatment modality selection depended on whether the patients desired larynx preservation. Patients with T1 disease without lesions or distant metastases underwent trans-oral tumor resection. The patients in the RT group were treated with conventional radical RT with a total dose of 60–70 Gy, with 1.8–2 Gy per fraction; all other RT procedures were conducted as previously described [12, 13]. In the RT group, 60 patients received concomitant chemotherapy, including 34 patients with docetaxel-based chemotherapy, 24 patients with cisplatin-based chemotherapy, and two patients with cetuximab-based chemotherapy; two patients were treated with RT alone due to a poor general condition. Five patients received planned neck dissection.

Following treatment, patients with early locoregional recurrence (LR) were identified at an outpatient clinic, and salvage therapy was conducted after treatment completion. Table 1 shows the clinical characteristics of all patients.

Table 1 Characteristics of study patients (No. of patients = 121)

FDG-PET/CT and image analysis

PET studies were conducted before treatment using a combined PET/CT scanner (Discovery ST Elite 16; GE Healthcare, Chicago, IL, USA). The patients fasted for at least four hours to ensure a serum glucose concentration of < 150-mg/dL before receiving an intravenous injection of 185-MBq/kg FDG (FDGscan; Nihon Medi-Physics, Tokyo, Japan), followed by PET scanning. A diagnostic CT scan for fusion was performed using a standard protocol without intravenous contrast (120-kV; auto mA range, 30–250-mA; noise index, 25; thickness, 3.75-mm; pitch, 1.75; beam collimation, 20-mm).

The FDG-uptake was calculated as the SUV with the following formula: SUV = tissue concentration (Bq/g)/{injection dose (Bq)/body weight (g)}. The SUVmax of the primary tumor was determined by the maximum SUV recorded within the region of interest around the tumor.

Statistical analysis

The median and interquartile range (IQR) were calculated for continuous variables. The predictive performance of SUVmax was assessed by receiver operating characteristic (ROC) curves and the total area under the curve (AUC). The 95% confidence intervals (CIs) for sensitivity, specificity, and AUC were calculated. The Youden index was used to determine the optimal SUVmax cutoff value for predicting a high risk of distant metastasis.

Univariate and multivariate Cox regression analyses were used to determine whether any clinical or treatment-related variables were predictors of distant metastases. Univariate factors with a p-value less than 0.05 were included in the multivariate analysis. The results are expressed as the hazard ratio (HR) with 95% CIs. Differences in overall and distant metastasis-free survival were compared using Kaplan–Meier curves and log-rank tests. For all tests, p < 0.05 was considered statistically significant. The analyses were performed using IBM SPSS Statistics 20.0 (IBM, Inc., Armonk, NY).

Results

Patient characteristics

A total of 121 patients with HPSCC were examined in this study, including 113 (93.4%) males and 8 (6.6%) females (Table 1). During diagnosis, the median age was 67 years (IQR 61–73). At the initial presentation, the tumors were staged as T3–T4 in 63 (52.1%) patients, N2–N3 in 84 (69.4%) patients, and overall III-IV in 98 (81.0%) patients. The pyriform sinus (n = 88, 72.7%) was the most common subsite of the main tumor. The median pretherapeutic SUVmax was 14.4 (IQR 11.8–19.7) for the whole cohort. Fifty-nine (48.8%) patients underwent primary surgery with or without combined postoperative radiotherapy or chemoradiotherapy, whereas 62 (51.2%) patients received primary radiotherapy or chemoradiotherapy. During the median follow-up of 28 months (IQR 14–44 months), recurrence or metastasis occurred in 59 (48.8%) patients at a median of 21 months (IQR 7–42 months). This recurrence or metastasis occurred in a locoregional site in 28 (23.1%) patients and at a distant site in 31 (25.6%) patients. Three patients displayed recurrence and metastasis in both locoregional and distant sites.

ROC curve analyses and cutoff values for quantitative measurements of FDG-PET/CT

In this study, an ROC curve analysis to determine the SUVmax value that was predictive of LR and distant metastasis, was performed, including the AUC analyses. It was found that the pretherapeutic SUVmax was predictive of distant metastasis and that the best potential cutoff value was 13.9 according to the Youden index (AUC = 0.709; 95% CI, 0.618–0.800; P = 0.001; sensitivity 93.5%; specificity 51.5%; P = 0.001, Fig. 1B). Conversely, the ROC curve for LR did not show a significant correlation (AUC = 0.487; 95% CI, 0.371–0.604; P = 0.837) (Fig. 1A).

Fig. 1
figure 1

Receiver operating characteristic (ROC) curve analysis of locoregional recurrence (LR) and distant metastasis prediction according to the pretherapeutic SUVmax of the primary tumor. A ROC curve for LR showing a lack of significant correlation [area under the curve (AUC) = 0.487] (95% CI = 0.371–0.604, P = 0.837). B ROC curve for distant metastasis. The area under the ROC curve was 0.709 (95% CI = 0.618–0.800, P = 0.001), and 13.9 was determined as the best potential cutoff value based on the Youden index. The sensitivity and specificity for an SUVmax of 13.9 were 93.5% and 51.5%, respectively

According to the pretherapeutic SUVmax of the primary tumor, the risk of distant metastasis was also evaluated in an ordinal fashion. For patients with a low SUVmax (< 13.9), the risk of distant metastasis was low. The risk of distant metastasis increased sharply with a higher SUVmax (≥ 13.9), as shown in Fig. 2.

Fig. 2
figure 2

Frequency curve showing the risk of distant metastases according to the SUVmax of the primary tumor arranged in an ordinal fashion. Patients with a low SUVmax (< 13.9) had a low risk of distant metastasis. The risk of distant metastasis increased sharply as the SUVmax increased

Risk factors for distant metastasis and patient survival

Factors possibly predicting distant metastasis were analyzed using univariate and multivariate Cox regression models (Table 2). Univariate analysis showed that T3/4 classification, N2/3 classification, clinical-stage IV, and a pretherapeutic SUVmax ≥ 13.9 were predictors of distant metastasis. The incidence of distant metastasis for these factors is detailed in Table 3. In the multivariate analysis, the only independent predictor of distant metastasis was a pretherapeutic primary tumor SUVmax ≥ 13.9 (HR = 8.61, 95% CI = 1.91–38.8, P = 0.005).

Table 2 Cox regression analysis for distantmetastasis-free survival for hypopharyngeal cancer patients (No. of patients = 121)
Table 3 Incidence of distant metastasis by TN and clinical stage, and SUVmax

Additionally, the relationship between pretherapeutic SUVmax and survival outcomes was evaluated. A comparative Kaplan–Meier survival analysis showed a worse distant metastasis-free and overall survival in patients with a pretherapeutic SUVmax ≥ 13.9 (Fig. 3A and B, log-rank test, P < 0.001, and P = 0.002, respectively).

Fig. 3
figure 3

Kaplan–Meier curves showing distant metastasis-free survival or overall survival. A A high SUVmax predicted poorer distant metastasis-free survival (A) and overall survival (B) in hypopharyngeal cancer patients (log-rank test, P < 0.001 and P = 0.002, respectively)

Discussion

Distant metastases of head and neck cancers are present in approximately 10% of cases at diagnosis, with additional 20%–30% developing metastases throughout their disease [14]. In addition to this clinically recognized occurrence, the incidence of distant metastases in autopsy series is three to four times higher than that in clinical series [15, 16]. Once distant metastasis occurs in head and neck squamous cell carcinoma (HNSCC), the prognosis is relatively poor (approximately ten months), even with the best treatments related to recent drug developments [17]. Thus, approximately 15–20% of patients with HNSCC die of distant metastasis [16].

HPSCC, in particular, has the most frequent incidence of distant metastasis among HNSCC [14, 16], and distant metastasis has occurred in 60% of patients who died of hypopharyngeal cancer [15]. Thus, distant metastasis is a clinically significant problem directly related to HNSCC prognosis, particularly HPSCC. However, it has long been highlighted that the head and neck cancer prognosis can be improved if distant metastasis can be controlled [18].

Recently, following the development of new drugs, particularly immune checkpoint inhibitors, it has become possible to prolong the survival of patients with distant metastasis [19, 20]. Therefore, predicting distant metastasis and performing appropriate treatment early is becoming increasingly important for improving HNSCC progonisis, particularly HPSCC.

This study examined 121 cases of HPSCC and found that the SUVmax in the primary lesion before treatment was an independent predictor of distant metastases. Notably, it was found that the low SUVmax group had few distant metastases, but metastases incidence increased rapidly above the cutoff value, as shown in Fig. 2. Conversely, following the T and N classifications, distant metastases were scattered, even at a relatively early stage (Table 3). Because of these characteristics, SUVmax may have been the only independent predictor of distant metastasis in multivariate analysis.

A higher uptake of FDG shows active tumor metabolism and correlates negatively with tumor oxygenation [21]. Many studies have revealed that poor tumor oxygenation or hypoxia is related to higher tumorigenicity, resulting in a poor clinical prognosis, including distant metastasis [22]. Alternatively, the SUVmax, which is obtained from FDG accumulation, directly reflects the condition inside the primary tumor. Therefore, SUVmax is thought to better judge the nature of the tumor, which is thought to be why SUVmax was considered an independent index of distant metastasis in this study.

In addition to SUVmax, metabolic tumor parameters derived from FDG-PET include metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Many studies have reported the usefulness of these parameters in head and neck cancer [23, 24]. However, among these metabolic parameters, SUVmax is thought to have an advantage over MTV and TLG because, in clinical practice, MTV and TLG are susceptible to fluctuations induced by differences in the definition of areas of interest and adjacent FDG-avid structures [5, 25]. These factors do not affect SUVmax. Therefore, SUVmax has only small differences among observers, is highly reliable and is easy to introduce compared with MTV and TLG [5, 26]. For these reasons, SUVmax is considered the most suitable metabolic tumor parameter derived from FDG-PET.

This study has several limitations. First, a comparatively small number of patients were obtained from only one institution, and a retrospective design was used. Secondly, the presence or absence of chemotherapy combined with radiation or surgery could not be considered. In addition to these limitations, the study included cases in which radiation therapy and surgical treatment was used as the initial treatment. In locally advanced cases, the primary site, the hypopharynx, may have been resected by surgery. In these cases, it is inevitably difficult to assess local recurrence. Therefore, it is possible that SUVmax was not a predictor of locoregional recurrence in this study.

Further large-scale studies that focus on the initial treatment of the target patients, with a prospective design is necessary.

Conclusively, this study highlights the role of SUVmax in pretreatment primary tumors of HPSCC and shows that SUVmax is significantly associated with distant metastasis, distant metastasis-free survival, and overall survival in a retrospective study.

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AUC:

Area under the curve

CT:

Computed tomography

FDG-PET:

18-Fluorodeoxyglucose positron emission tomography

HNSCC:

Head and neck squamous cell carcinoma

HPSCC:

Hypopharyngeal squamous cell carcinoma

ROC:

Receiver operating characteristic

SUVmax:

Maximum standardized uptake value

References

  1. Newman JR, Connolly TM, Illing EA, Kilgore ML, Locher JL, Carroll WR. Survival trends in hypopharyngeal cancer: a population-based review. Laryngoscope. 2015;125:624–9. https://doi.org/10.1002/lary.24915.

    Article  PubMed  Google Scholar 

  2. Creff G, Devillers A, Depeursinge A, Palard-Novello X, Acosta O, Jegoux F, Castelli J. Evaluation of the prognostic value of FDG PET/CT parameters for patients with surgically treated head and neck cancer: a systematic review. JAMA Otolaryngol Head Neck Surg. 2020;146:471–9. https://doi.org/10.1001/jamaoto.2020.0014.

    Article  PubMed  Google Scholar 

  3. Li Y, Ou X, Hu C. Prevalence and prognostic impact of synchronous distant metastases in patients with hypopharynx squamous cell carcinomas: a SEER-based study. J Cancer. 2019;10:620–6. https://doi.org/10.7150/jca.28554.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Spector GJ. Distant metastases from laryngeal and hypopharyngeal cancer. ORL. 2001;63:224–8. https://doi.org/10.1159/000055746.

    CAS  Article  PubMed  Google Scholar 

  5. Castelli J, De Bari B, Depeursinge A, Simon A, Devillers A, Roman Jimenez G, Prior J, Ozsahin M, de Crevoisier R, Bourhis J. Overview of the predictive value of quantitative 18 FDG PET in head and neck cancer treated with chemoradiotherapy. Crit Rev Oncol Hematol. 2016;108:40–51. https://doi.org/10.1016/j.critrevonc.2016.10.009.

    CAS  Article  PubMed  Google Scholar 

  6. Doi H, Kitajima K, Fukushima K, Kawanaka Y. SUV max on FDG-PET is a predictor of prognosis in patients with maxillary sinus cancer. Jpn J Radiol. 2016;34:349–55. https://doi.org/10.1007/s11604-016-0531-9.

    Article  PubMed  Google Scholar 

  7. Suzuki H, Kato K, Fujimoto Y, Itoh Y, Hiramatsu M, Maruo T, Naganawa S, Hasegawa Y, Nakashima T. 18F-FDG-PET/CT predicts survival in hypopharyngeal squamous cell carcinoma. Ann Nucl Med. 2013;27:297–302. https://doi.org/10.1007/s12149-013-0686-8.

    CAS  Article  PubMed  Google Scholar 

  8. Werner J, Hüllner MW, Rupp NJ, Huber AM, Broglie MA, Huber GF, Morand GB. Predictive value of pretherapeutic maximum standardized uptake value (Suvmax) in laryngeal and hypopharyngeal cancer. Sci Rep. 2019;9:1–10. https://doi.org/10.1038/s41598-019-45462-y.

    CAS  Article  Google Scholar 

  9. Lee JR, Almuhaimid TM, Roh JL, Oh JS, Kim SJ, Kim JS, Choi SH, Nam SY, Kim SY. Prognostic value of 18F-FDG PET/CT parameters in patients who undergo salvage treatments for recurrent squamous cell carcinoma of the larynx and hypopharynx. J Surg Oncol. 2018;118:644–50. https://doi.org/10.1002/jso.25185.

    Article  PubMed  Google Scholar 

  10. Suzuki H, Kato K, Nishio M, Tamaki T, Fujimoto Y, Hiramatsu M, Hanai N, Kodaira T, Itoh Y, Naganawa S, et al. FDG-PET/CT predicts survival and lung metastasis of hypopharyngeal cancer in a multi-institutional retrospective study. Ann Nucl Med. 2017;31:514–20. https://doi.org/10.1007/s12149-017-1176-1.

    CAS  Article  PubMed  Google Scholar 

  11. Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours, 8th edition | Wiley. Wiley-Blackwell (2017) Available at: https://www.wiley.com/en-us/TNM+Classification+of+Malignant+Tumours,+8th+Edition-p-9781119263579. Accessed January 12, 2022

  12. Ishizuka M, Fujimoto Y, Itoh Y, Kitagawa K, Sano M, Miyagawa Y, Ando A, Hiramatsu M, Hirasawa N, Ishihara S, et al. Relationship between hematotoxicity and serum albumin level in the treatment of head and neck cancers with concurrent chemoradiotherapy using cisplatin. Jpn J Clin Oncol. 2011;41:973–9. https://doi.org/10.1093/jjco/hyr076.

    Article  PubMed  Google Scholar 

  13. Nakahara R, Kodaira T, Furutani K, Tachibana H, Tomita N, Inokuchi H, Mizoguchi N, Goto Y, Ito Y, Naganawa S. Treatment outcomes of definitive chemoradiotherapy for patients with hypopharyngeal cancer. J Radiat Res. 2012;53:906–15. https://doi.org/10.1093/jrr/rrs052.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pisani P, Airoldi M, Allais A, Valletti PA, Battista M, Benazzo M, Briatore R, Cacciola S, Cocuzza S, Colombo A, et al. Metastatic disease in head and neck oncology. Acta Otorhinolaryngol Ital. 2020;40:S1–86. https://doi.org/10.14639/0392-100X-suppl.1-40-2020.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kotwall C, Sako K, Razack MS, Rao U, Bakamjian V, Shedd DP. Metastatic patterns in squamous cell cancer of the head and neck. Am J Surg. 1987;154:439–42. https://doi.org/10.1016/0002-9610(89)90020-2.

    CAS  Article  PubMed  Google Scholar 

  16. Duprez F, Berwouts D, De Neve W, Bonte K, Boterberg T, Deron P, Huvenne W, Rottey S, Mareel M. Distant metastases in head and neck cancer. Head Neck. 2017;39:1733–43. https://doi.org/10.1002/hed.24687.

    Article  PubMed  Google Scholar 

  17. Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S, Erfan J, Zabolotnyy D, Kienzer H-R, Cupissol D, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med. 2008;359:1116–27. https://doi.org/10.1056/NEJMoa0802656.

    CAS  Article  PubMed  Google Scholar 

  18. Wiegand S. Survival after distant metastasis in head and neck cancer. Head Neck. 2016;38:140–6. https://doi.org/10.1002/hed.23861.

    Article  PubMed  Google Scholar 

  19. Ferris RL, Blumenschein G, Fayette J, Guigay J, Colevas AD, Licitra L, Harrington K, Kasper S, Vokes EE, Even C, et al. Nivolumab for recurrent squamous-cell carcinoma of the head and neck. N Engl J Med. 2016;375:1856–67. https://doi.org/10.1056/NEJMoa1602252.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  20. Burtness B, Harrington KJ, Greil R, Soulières D, Tahara M, de Castro G, Psyrri A, Basté N, Neupane P, Bratland Å, et al. Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study. Lancet. 2019;394:1915–28. https://doi.org/10.1016/S0140-6736(19)32591-7.

    CAS  Article  PubMed  Google Scholar 

  21. Wilson WR, Hay MP. Targeting hypoxia in cancer therapy. Nat Rev Cancer. 2011;11:393–410. https://doi.org/10.1038/nrc3064.

    CAS  Article  Google Scholar 

  22. Rankin EB, Giaccia AJ. Hypoxic control of metastasis. Science. 2016;352:175–80. https://doi.org/10.1126/science.aaf4405.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. Pak K, Cheon GJ, Nam HY, Kim SJ, Kang KW, Chung JK, Kim EE, Lee DS. Prognostic value of metabolic tumor volume and total lesion glycolysis in head and neck cancer: a systematic review and meta-analysis. J Nucl Med. 2014;55:884–90. https://doi.org/10.2967/jnumed.113.133801.

    CAS  Article  PubMed  Google Scholar 

  24. Park GC, Kim JS, Roh JL, Choi SH, Nam SY, Kim SY. Prognostic value of metabolic tumor volume measured by 18F-FDG PET/CT in advanced-stage squamous cell carcinoma of the larynx and hypopharynx. Ann Oncol. 2013;24:208–14. https://doi.org/10.1093/annonc/mds247.

    CAS  Article  PubMed  Google Scholar 

  25. Krak NC, Boellaard R, Hoekstra OS, Twisk JWR, Hoekstra CJ, Lammertsma AA. Effects of ROI definition and reconstruction method on quantitative outcome and applicability in a response monitoring trial. Eur J Nucl Med Mol Imaging. 2005;32:294–301. https://doi.org/10.1007/s00259-004-1566-1.

    Article  PubMed  Google Scholar 

  26. Paidpally V, Chirindel A, Lam S, Agrawal N, Quon H, Subramaniam RM. FDG-PET/CT imaging biomarkers in head and neck squamous cell carcinoma. Imaging Med. 2012;4:633–47. https://doi.org/10.2217/iim.12.60.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors thank Yoshihiro Abukawa for providing information about FDG-PET/CT in our institution.

Funding

The present study was supported by a Grant-in-Aid for Scientific Research (C) (Grant no. 18K09337) from the Ministry of Education, Culture, Sports, Science and Technology, Japan.

Author information

Affiliations

Authors

Contributions

SS: conceptualization, design, and writing-original draft preparation. ST, TA, TE, and TK: data acquisition and interpretation. TY: supervision. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Shinsuke Suzuki.

Ethics declarations

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Suzuki, S., Toyoma, S., Abe, T. et al. 18F-FDG-PET/CT can be used to predict distant metastasis in hypopharyngeal squamous cell carcinoma. J of Otolaryngol - Head & Neck Surg 51, 13 (2022). https://doi.org/10.1186/s40463-022-00568-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s40463-022-00568-8

Keywords

  • Hypopharyngeal squamous cell carcinoma
  • Distant metastasis
  • 18F-FDG-PET/CT
  • Maximum standardized uptake value
  • Survival